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Hertenstein E, Trinca E, Schneider CL, Fehér KD, Johann AF, Nissen C. Acceptance and Commitment Therapy, Combined with Bedtime Restriction, versus Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Pilot Trial. Psychother Psychosom 2024; 93:114-128. [PMID: 38417415 DOI: 10.1159/000535834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/08/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Cognitive behavioral therapy for insomnia (CBT-I) is the current first-line treatment for insomnia. However, rates of nonresponse and nonremission are high and effects on quality of life are only small to moderate, indicating a need for novel treatment developments. We propose that Acceptance and Commitment Therapy (ACT) addresses core pathophysiological pathways of insomnia. ACT therefore has the potential to improve treatment efficacy when combined with bedtime restriction, the most effective component of CBT-I. The aim of this study was to compare the efficacy of ACT for insomnia combined with bedtime restriction (ACT-I) and CBT-I in improving insomnia severity and sleep-related quality of life. METHODS Sixty-three patients with insomnia disorder (mean age 52 years, 65% female, 35% male) were randomly assigned to receive either ACT-I or CBT-I in a group format. The primary outcomes were insomnia severity (Insomnia Severity Index) and sleep-related quality of life (Glasgow Sleep Impact Index). Outcomes were assessed before randomization (T0), directly after treatment (T1), and at 6-month follow-up (T2). RESULTS The results indicated significant, large pre-to-post improvements in both groups, for both primary and secondary outcomes. Improvements were maintained at the 6-month follow-up. However, there was no significant group by time interactions in linear mixed models, indicating an absence of differential efficacy. On a subjective treatment satisfaction scale, patients in the ACT-I group indicated significantly greater satisfaction with their improvement of several aspects of health including their energy level and work productivity. CONCLUSIONS The results suggest that ACT-I is feasible and effective, but not more effective than CBT-I for the improvement of insomnia severity and sleep-related quality of life. Future studies are needed to assess whether ACT-I is noninferior to CBT-I and to shed light on mechanisms of change in both treatments.
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Affiliation(s)
- Elisabeth Hertenstein
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ersilia Trinca
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer D Fehér
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anna F Johann
- Clinic for Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
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Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, Bastien C, Berzina N, Bjorvatn B, Dikeos D, Dolenc Groselj L, Ellis JG, Garcia-Borreguero D, Geoffroy PA, Gjerstad M, Gonçalves M, Hertenstein E, Hoedlmoser K, Hion T, Holzinger B, Janku K, Jansson-Fröjmark M, Järnefelt H, Jernelöv S, Jennum PJ, Khachatryan S, Krone L, Kyle SD, Lancee J, Leger D, Lupusor A, Marques DR, Nissen C, Palagini L, Paunio T, Perogamvros L, Pevernagie D, Schabus M, Shochat T, Szentkiralyi A, Van Someren E, van Straten A, Wichniak A, Verbraecken J, Spiegelhalder K. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023; 32:e14035. [PMID: 38016484 DOI: 10.1111/jsr.14035] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).
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Affiliation(s)
- Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | | | - Erna Sif Arnardottir
- Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland
- Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Chiara Baglioni
- Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy
| | | | - Celyne Bastien
- École de Psychologie, Université Laval, Québec, Québec, Canada
| | | | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dimitris Dikeos
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Leja Dolenc Groselj
- Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Jason G Ellis
- Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK
| | | | | | | | | | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kerstin Hoedlmoser
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tuuliki Hion
- East-Viru Central Hospital, Kohtla-Järve, Estonia
| | | | - Karolina Janku
- Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic
| | - Markus Jansson-Fröjmark
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Heli Järnefelt
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden
| | - Poul Jørgen Jennum
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Samson Khachatryan
- Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia
| | - Lukas Krone
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
- Department of Neurology, Inselspital, University of Bern, Berne, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Damien Leger
- Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France
| | - Adrian Lupusor
- Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova
| | - Daniel Ruivo Marques
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Christoph Nissen
- Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland
| | - Laura Palagini
- Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy
| | - Tiina Paunio
- Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Dirk Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Manuel Schabus
- Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria
| | - Tamar Shochat
- The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel
| | - Andras Szentkiralyi
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adam Wichniak
- Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Schneider CL, Hertenstein E, Nissen C. Cognitive behavioural therapy for insomnia in inpatient psychiatric care: a systematic review. J Sleep Res 2023; 32:e14041. [PMID: 37726877 DOI: 10.1111/jsr.14041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023]
Abstract
Insomnia is highly prevalent among patients with psychiatric disorders. According to current guidelines, cognitive behavioural therapy for insomnia (CBT-I) represents the first-line treatment for chronic insomnia, also for patients with psychiatric comorbidity. While recent studies have demonstrated that CBT-I not only improves insomnia but also other health outcomes in patients with psychiatric disorders and comorbid insomnia in outpatient settings, the level of implementation and treatment potential of CBT-I in inpatient psychiatry is less clear. The objective of this systematic review is to present and discuss studies that have adapted CBT-I for inpatient psychiatric care. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO, were searched until June 2023. A total of 10 studies were identified, with the majority being non-randomised trials without comparison groups and small sample sizes. With preliminary character, studies report feasibility and potential efficacy in inpatient settings. Together, this review identifies a paucity of studies on CBT-I or derivates in inpatient psychiatry. Despite challenging in this setting, studies adapting CBT-I to the needs of severely ill patients and hospital settings might have the potential to improve mental health care.
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Affiliation(s)
- Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph Nissen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
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Wunderlin M, Zeller CJ, Senti SR, Fehér KD, Suppiger D, Wyss P, Koenig T, Teunissen CE, Nissen C, Klöppel S, Züst MA. Acoustic stimulation during sleep predicts long-lasting increases in memory performance and beneficial amyloid response in older adults. Age Ageing 2023; 52:afad228. [PMID: 38163288 PMCID: PMC10758173 DOI: 10.1093/ageing/afad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Sleep and neurodegeneration are assumed to be locked in a bi-directional vicious cycle. Improving sleep could break this cycle and help to prevent neurodegeneration. We tested multi-night phase-locked acoustic stimulation (PLAS) during slow wave sleep (SWS) as a non-invasive method to improve SWS, memory performance and plasma amyloid levels. METHODS 32 healthy older adults (agemean: 68.9) completed a between-subject sham-controlled three-night intervention, preceded by a sham-PLAS baseline night. RESULTS PLAS induced increases in sleep-associated spectral-power bands as well as a 24% increase in slow wave-coupled spindles, known to support memory consolidation. There was no significant group-difference in memory performance or amyloid-beta between the intervention and control group. However, the magnitude of PLAS-induced physiological responses were associated with memory performance up to 3 months post intervention and beneficial changes in plasma amyloid. Results were exclusive to the intervention group. DISCUSSION Multi-night PLAS is associated with long-lasting benefits in memory and metabolite clearance in older adults, rendering PLAS a promising tool to build upon and develop long-term protocols for the prevention of cognitive decline.
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Affiliation(s)
- Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
| | - Céline Jacqueline Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012 Bern, Switzerland
| | - Samira Rafaela Senti
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Kristoffer Daniel Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Debora Suppiger
- Department of Neonatology, University Hospital Zurich and University of Zurich, 8006 Zürich, Switzerland
| | - Patric Wyss
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Thomas Koenig
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Charlotte Elisabeth Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1205 Geneva, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
| | - Marc Alain Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern, Switzerland
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Frase L, Nissen C, Spiegelhalder K, Feige B. The importance and limitations of polysomnography in insomnia disorder-a critical appraisal. J Sleep Res 2023; 32:e14036. [PMID: 37680011 DOI: 10.1111/jsr.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the science regarding PSG indications and findings in ID, and the indications to conduct PSG in ID as stated by relevant guidelines. It then highlights the most relevant questions regarding the topic, including the relevance of ID subtyping, to allow an individualised pharmacological or psychotherapeutic treatment approach.
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Affiliation(s)
- Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hertenstein E, Schneider C, Nissen C. [Insomnia]. Dtsch Med Wochenschr 2023; 148:1384-1390. [PMID: 37820649 DOI: 10.1055/a-2182-0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Patients with insomnia suffer from problems falling asleep and/or maintaining sleep. This has a negative effect on their daytime wellbeing and performance. Insomnia is primarily diagnosed by a detailed clinical history, supplemented by questionnaires and sleep diaries. Polysomnography may be necessary for the differential diagnosis of organic sleep disorders. Insomnia is a frequent comorbidity of most mental disorders and many physical diseases. It is treated according to guidelines with cognitive behavioural therapy for insomnia (CBT-I). CBT-I is offered in individual or group format as well as online-supported treatment. If behavioural therapy is not effective or not available, pharmacotherapy can be discussed.
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Hertenstein E, Perogamvros L, Schneider CL, Nissen C. [Insomnia in psychiatry and psychotherapy]. Rev Med Suisse 2023; 19:1686-1689. [PMID: 37728260 DOI: 10.53738/revmed.2023.19.842.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Insomnia disorder is characterized by disturbed sleep continuity and associated daytime impairment. Insomnia is frequent in patients with psychiatric disorders ; 30-40% fulfill the criteria for insomnia disorder as a comorbidity. According to current guidelines, cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment, comprising sleep education, bedtime restriction, relaxation and cognitive restructuring. Despite guideline recommendations, CBT-I is insufficiently implemented, and insomnia is frequently over-treated with hypnotics. 'Become your own SLEEPexpert' is a behavioral treatment program based on CBT-I with the aim of empowering patients to take care of their own sleep health.
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Affiliation(s)
- Elisabeth Hertenstein
- Psychologue, PhD, Service des spécialités psychiatriques, Département de psychiatrie, Faculté de médecine, Université de Genève, 1211 Genève 4
| | - Lampros Perogamvros
- Centre de médecine du sommeil, Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Carlotta L Schneider
- Psychhologue, M.Sc., Service universitaire de psychiatrie, Université de Berne, 3012 Berne
| | - Christoph Nissen
- Centre de médecine du sommeil, Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, 1211 Genève 14
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Hertenstein E, Kuhn M, Landmann N, Maier JG, Schneider CL, Fehér KD, Frase L, Riemann D, Feige B, Nissen C. Brain-derived neurotrophic factor genetic polymorphism rs6265 and creativity. PLoS One 2023; 18:e0291397. [PMID: 37703265 PMCID: PMC10499242 DOI: 10.1371/journal.pone.0291397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023] Open
Abstract
The protein brain-derived neurotrophic factor (BDNF) promotes neural plasticity of the central nervous system and plays an important role for learning and memory. A single nucleotide polymorphism (rs6265) at position 66 in the pro-region of the human BDNF gene, resulting in a substitution of the amino acid valine (val) with methionine (met), leads to attenuated BDNF secretion and has been associated with reduced neurocognitive function. Inhomogeneous results have been found regarding the effect of the BDNF genotype on behavior. We determined the BDNF genotype and performance on the Compound Remote Associate (CRA) task as a common measure of creativity in 76 healthy university students. In our main analyses, we did not find significant differences between met-carriers (n = 30) and non-met carriers (n = 46). In a secondary analysis, we found that met-carriers had a slower solution time (medium effect size) for items of medium difficulty. Our results suggest that met-carriers and non-met-carriers do not generally differ regarding their creativity, but non-met-carriers may have a certain advantage when it comes to moderately difficult problems. The wider literature suggests that both genetic variants come with advantages and disadvantages. Future research needs to sharpen our understanding of the disadvantages and, potentially, advantages met allele carriers may have.
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Affiliation(s)
- Elisabeth Hertenstein
- Faculty of Medicine, Department of Psychiatry, University of Geneva, Geneva, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marion Kuhn
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center–University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Nina Landmann
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center–University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jonathan-Gabriel Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | | | - Lukas Frase
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center–University of Freiburg, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Department of Psychosomatic Medicine and Psychotherapy, Medical Center–University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Dieter Riemann
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center–University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center–University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Faculty of Medicine, Department of Psychiatry, University of Geneva, Geneva, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
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Züst MA, Mikutta C, Omlin X, DeStefani T, Wunderlin M, Zeller CJ, Fehér KD, Hertenstein E, Schneider CL, Teunissen CE, Tarokh L, Klöppel S, Feige B, Riemann D, Nissen C. The Hierarchy of Coupled Sleep Oscillations Reverses with Aging in Humans. J Neurosci 2023; 43:6268-6279. [PMID: 37586871 PMCID: PMC10490476 DOI: 10.1523/jneurosci.0586-23.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023] Open
Abstract
A well orchestrated coupling hierarchy of slow waves and spindles during slow-wave sleep supports memory consolidation. In old age, the duration of slow-wave sleep and the number of coupling events decrease. The coupling hierarchy deteriorates, predicting memory loss and brain atrophy. Here, we investigate the dynamics of this physiological change in slow wave-spindle coupling in a frontocentral electroencephalography position in a large sample (N = 340; 237 females, 103 males) spanning most of the human life span (age range, 15-83 years). We find that, instead of changing abruptly, spindles gradually shift from being driven by slow waves to driving slow waves with age, reversing the coupling hierarchy typically seen in younger brains. Reversal was stronger the lower the slow-wave frequency, and starts around midlife (age range, ∼40-48 years), with an established reversed hierarchy between 56 and 83 years of age. Notably, coupling strength remains unaffected by age. In older adults, deteriorating slow wave-spindle coupling, measured using the phase slope index (PSI) and the number of coupling events, is associated with blood plasma glial fibrillary acidic protein levels, a marker for astrocyte activation. Data-driven models suggest that decreased sleep time and higher age lead to fewer coupling events, paralleled by increased astrocyte activation. Counterintuitively, astrocyte activation is associated with a backshift of the coupling hierarchy (PSI) toward a "younger" status along with increased coupling occurrence and strength, potentially suggesting compensatory processes. As the changes in coupling hierarchy occur gradually starting at midlife, we suggest there exists a sizable window of opportunity for early interventions to counteract undesirable trajectories associated with neurodegeneration.SIGNIFICANCE STATEMENT Evidence accumulates that sleep disturbances and cognitive decline are bidirectionally and causally linked, forming a vicious cycle. Improving sleep quality could break this cycle. One marker for sleep quality is a clear hierarchical structure of sleep oscillations. Previous studies showed that sleep oscillations decouple in old age. Here, we show that, rather, the hierarchical structure gradually shifts across the human life span and reverses in old age, while coupling strength remains unchanged. This shift is associated with markers for astrocyte activation in old age. The shifting hierarchy resembles brain maturation, plateau, and wear processes. This study furthers our comprehension of this important neurophysiological process and its dynamic evolution across the human life span.
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Affiliation(s)
- Marc Alain Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Private Clinic Meiringen, 3860 Meiringen, Switzerland
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford OX1 3PT, United Kingdom
| | - Ximena Omlin
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Tatjana DeStefani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Céline Jacqueline Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Kristoffer Daniel Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1201 Geneva, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Charlotte Elisabeth Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Leila Tarokh
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, 79104 Freiburg, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, 79104 Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3000 Bern 60, Switzerland
- Division of Psychiatric Specialties, Geneva University Hospitals (HUG), 1201 Geneva, Switzerland
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10
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Bielinski LL, Wälchli G, Nissen C, Berger T, Moggi F. Does an Internet-Based Emotion Regulation Intervention Provide Added Value for Acute Psychiatric Inpatient Care? Protocol for a Randomized Controlled Pilot Trial. JMIR Res Protoc 2023; 12:e47656. [PMID: 37432724 PMCID: PMC10369307 DOI: 10.2196/47656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND There is a lack of studies on internet-based interventions in inpatient settings. This is especially true for studies of internet-based interventions in acute psychiatric inpatient care. Internet-based interventions in this specific setting may provide benefits such as patient empowerment and overall improved treatment outcomes. However, there may also be specific barriers to their implementation that are unique due to the complexity of acute psychiatric inpatient care. OBJECTIVE The aim of this study is to examine the feasibility and preliminary evidence for effectiveness of a web-based emotion regulation intervention provided as an add-on to acute psychiatric inpatient care. METHODS The goal is to randomly allocate 60 patients with a range of different diagnoses in a 1:1 ratio to either treatment as usual (TAU), which consists of acute psychiatric inpatient treatment, or to the intervention group, which will receive TAU plus access to a web-based intervention that focuses on reduction of emotion regulation difficulties and improvement of emotion regulation skills. The primary outcome is symptom severity, assessed with the short form of the Brief Symptom Inventory at baseline, after 4 weeks, after 8 weeks, and at hospital discharge. Secondary outcomes include 2 emotion regulation parameters, intervention use, usability, patient satisfaction, and reasons for patient loss to follow-up. RESULTS Participant recruitment started in August 2021 and as of March 2023 was ongoing. First publication of study results is expected in 2024. CONCLUSIONS This study protocol describes a study that intends to examine a web-based emotion regulation intervention in acute psychiatric inpatient care. The study will provide information on the feasibility of the intervention and possible effects on symptom severity and emotion regulation. The results will provide new insights on blended treatment, in this case the combination of a web-based intervention and face-to-face psychiatric treatment, in an understudied patient group and setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04990674; https://clinicaltrials.gov/ct2/show/NCT04990674. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47656.
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Affiliation(s)
- Laura Luisa Bielinski
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Gwendolyn Wälchli
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- Division of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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11
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Hertenstein E, Riemann D, Nissen C. Comment on Yue et al., 2023: "Efficacy and tolerability of pharmacological treatments for insomnia in adults: A systematic review and network meta-analysis". Sleep Med Rev 2023; 69:101772. [PMID: 36940555 DOI: 10.1016/j.smrv.2023.101772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 03/13/2023]
Affiliation(s)
- Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Christoph Nissen
- Service des Spécialités Psychiatriques, Hôpitaux Universitaires de Genève (HUG), Switzerland
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12
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Johann AF, Feige B, Hertenstein E, Nissen C, Benz F, Steinmetz L, Baglioni C, Riemann D, Spiegelhalder K, Akram U. The Effects of Cognitive Behavioral Therapy for Insomnia on Multidimensional Perfectionism. Behav Ther 2023; 54:386-399. [PMID: 36858767 DOI: 10.1016/j.beth.2022.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
Perfectionism is related to insomnia and objective markers of disturbed sleep. This study examined whether multidimensional perfectionism is related to dysfunctional beliefs about sleep, sleep-effort, pre-sleep arousal, and polysomnography-determined markers of sleep among individuals with insomnia. The effects of cognitive behavioral therapy for insomnia (CBT-I) on perfectionism was also examined. This was a secondary analysis of a randomized controlled trial on CBT-I. Forty-three insomnia patients were randomized to treatment (receiving CBT-I) or waitlist control groups. Sleep was recorded using polysomnography at baseline. Participants completed measures of perfectionism, dysfunctional beliefs about sleep, sleep-effort and pre-sleep arousal at baseline and posttreatment. Total perfectionism scores and doubts about action, concern over mistakes and personal standards were each significantly related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep at baseline. Patients receiving treatment displayed increased total perfectionism scores posttreatment d = .49. In those receiving treatment, levels of organization d = .49 and parental expectations d = .47 were significantly increased posttreatment, relative to baseline. In line with the literature, our results confirm that perfectionism is related to insomnia. Here, insomnia was related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep. The propensity to maintain a high standard of order and organization may be elevated following CBT-I, considering the treatment protocol expects patients to strictly adhere to a set of clearly defined rules. Levels of parental expectations may be increased following CBT-I since the patient-therapist-relationship may trigger implicit expectations in patients which are reminiscent of their relationship to their parents.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Umair Akram
- Sheffield Hallam University, University of Lincoln.
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13
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Fehér KD, Omlin X, Tarokh L, Schneider CL, Morishima Y, Züst MA, Wunderlin M, Koenig T, Hertenstein E, Ellenberger B, Ruch S, Schmidig F, Mikutta C, Trinca E, Senn W, Feige B, Klöppel S, Nissen C. Feasibility, efficacy, and functional relevance of automated auditory closed-loop suppression of slow-wave sleep in humans. J Sleep Res 2023:e13846. [PMID: 36806335 DOI: 10.1111/jsr.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/22/2022] [Accepted: 01/23/2023] [Indexed: 02/22/2023]
Abstract
Slow-wave sleep (SWS) is a fundamental physiological process, and its modulation is of interest for basic science and clinical applications. However, automatised protocols for the suppression of SWS are lacking. We describe the development of a novel protocol for the automated detection (based on the whole head topography of frontal slow waves) and suppression of SWS (through closed-loop modulated randomised pulsed noise), and assessed the feasibility, efficacy and functional relevance compared to sham stimulation in 15 healthy young adults in a repeated-measure sleep laboratory study. Auditory compared to sham stimulation resulted in a highly significant reduction of SWS by 30% without affecting total sleep time. The reduction of SWS was associated with an increase in lighter non-rapid eye movement sleep and a shift of slow-wave activity towards the end of the night, indicative of a homeostatic response and functional relevance. Still, cumulative slow-wave activity across the night was significantly reduced by 23%. Undisturbed sleep led to an evening to morning reduction of wake electroencephalographic theta activity, thought to reflect synaptic downscaling during SWS, while suppression of SWS inhibited this dissipation. We provide evidence for the feasibility, efficacy, and functional relevance of a novel fully automated protocol for SWS suppression based on auditory closed-loop stimulation. Future work is needed to further test for functional relevance and potential clinical applications.
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Affiliation(s)
- Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Ximena Omlin
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Leila Tarokh
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Yosuke Morishima
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Social Neuroscience and Social Psychology, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Thomas Koenig
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Simon Ruch
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany
| | - Flavio Schmidig
- Cognitive Neuroscience of Memory and Consciousness, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Ersilia Trinca
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Walter Senn
- Institute of Physiology, University of Bern, Bern, Switzerland
| | - Bernd Feige
- University of Freiburg Medical Center, Freiburg, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
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14
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Zeller CJ, Züst MA, Wunderlin M, Nissen C, Klöppel S. The promise of portable remote auditory stimulation tools to enhance slow-wave sleep and prevent cognitive decline. J Sleep Res 2023:e13818. [PMID: 36631001 DOI: 10.1111/jsr.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
Dementia is the seventh leading cause of mortality, and a major source of disability and dependency in older individuals globally. Cognitive decline (and, to a lesser extent, normal ageing) are associated with sleep fragmentation and loss of slow-wave sleep. Evidence suggests a bidirectional causal link between these losses. Phase-locked auditory stimulation has emerged as a promising non-invasive tool to enhance slow-wave sleep, potentially ameliorating cognitive decline. In laboratory settings, auditory stimulation is usually supervised by trained experts. Different algorithms (simple amplitude thresholds, topographic correlation, sine-wave fitting, phase-locked loop, and phase vocoder) are used to precisely target auditory stimulation to a desired phase of the slow wave. While all algorithms work well in younger adults, the altered sleep physiology of older adults and particularly those with neurodegenerative disorders requires a tailored approach that can adapt to older adults' fragmented sleep and reduced amplitudes of slow waves. Moreover, older adults might require a continuous intervention that is not feasible in laboratory settings. Recently, several auditory stimulation-capable portable devices ('Dreem®', 'SmartSleep®' and 'SleepLoop®') have been developed. We discuss these three devices regarding their potential as tools for science, and as clinical remote-intervention tools to combat cognitive decline. Currently, SleepLoop® shows the most promise for scientific research in older adults due to high transparency and customizability but is not commercially available. Studies evaluating down-stream effects on cognitive abilities, especially in patient populations, are required before a portable auditory stimulation device can be recommended as a clinical preventative remote-intervention tool.
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Affiliation(s)
- Céline J Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Division of Psychiatric Specialties, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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15
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Bozic I, Rusterholz T, Mikutta C, Del Rio-Bermudez C, Nissen C, Adamantidis A. Coupling between the prelimbic cortex, nucleus reuniens, and hippocampus during NREM sleep remains stable under cognitive and homeostatic demands. Eur J Neurosci 2023; 57:106-128. [PMID: 36310348 DOI: 10.1111/ejn.15853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 02/02/2023]
Abstract
The interplay between the medial prefrontal cortex and hippocampus during non-rapid eye movement (NREM) sleep contributes to the consolidation of contextual memories. To assess the role of the thalamic nucleus reuniens (Nre) in this interaction, we investigated the coupling of neuro-oscillatory activities among prelimbic cortex, Nre, and hippocampus across sleep states and their role in the consolidation of contextual memories using multi-site electrophysiological recordings and optogenetic manipulations. We showed that ripples are time-locked to the Up state of cortical slow waves, the transition from UP to DOWN state in thalamic slow waves, the troughs of cortical spindles, and the peaks of thalamic spindles during spontaneous sleep, rebound sleep and sleep following a fear conditioning task. In addition, spiking activity in Nre increased before hippocampal ripples, and the phase-locking of hippocampal ripples and thalamic spindles during NREM sleep was stronger after acquisition of a fear memory. We showed that optogenetic inhibition of Nre neurons reduced phase-locking of ripples to cortical slow waves in the ventral hippocampus whilst their activation altered the preferred phase of ripples to slow waves in ventral and dorsal hippocampi. However, none of these optogenetic manipulations of Nre during sleep after acquisition of fear conditioning did alter sleep-dependent memory consolidation. Collectively, these results showed that Nre is central in modulating hippocampus and cortical rhythms during NREM sleep.
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Affiliation(s)
- Ivan Bozic
- Zentrum für Experimentelle Neurologie, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.,Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Thomas Rusterholz
- Zentrum für Experimentelle Neurologie, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.,Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Carlos Del Rio-Bermudez
- Zentrum für Experimentelle Neurologie, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.,Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Antoine Adamantidis
- Zentrum für Experimentelle Neurologie, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland.,Department of Biomedical Research, University of Bern, Bern, Switzerland.,Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
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16
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Trinca E, Hertenstein E, Wunderlin M, Schneider C, Züst, Fehér K, Su T, Van Straten A, Berger T, Riemann D, Feige B, Nissen C. Cognitive Behavioral Therapy for Insomnia in Patients with Mental Disorders and Comorbid Insomnia: A Systematic Review and Meta-Analysis. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Wunderlin M, Koenig T, Zeller C, Nissen C, Züst MA. Automatized online prediction of slow-wave peaks during non-rapid eye movement sleep in young and old individuals: Why we should not always rely on amplitude thresholds. J Sleep Res 2022; 31:e13584. [PMID: 35274389 PMCID: PMC9787564 DOI: 10.1111/jsr.13584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/02/2022] [Accepted: 02/25/2022] [Indexed: 12/30/2022]
Abstract
Brain-state-dependent stimulation during slow-wave sleep is a promising tool for the treatment of psychiatric and neurodegenerative diseases. A widely used slow-wave prediction algorithm required for brain-state-dependent stimulation is based on a specific amplitude threshold in the electroencephalogram. However, due to decreased slow-wave amplitudes in aging and psychiatric conditions, this approach might miss many slow-waves because they do not fulfill the amplitude criterion. Here, we compared slow-wave peaks predicted via an amplitude-based versus a multidimensional approach using a topographical template of slow-wave peaks in 21 young and 21 older healthy adults. We validate predictions against the gold-standard of offline detected peaks. Multidimensionally predicted peaks resemble the gold-standard regarding spatiotemporal dynamics but exhibit lower peak amplitudes. Amplitude-based prediction, by contrast, is less sensitive, less precise and - especially in the older group - predicts peaks that differ from the gold-standard regarding spatiotemporal dynamics. Our results suggest that amplitude-based slow-wave peak prediction might not always be the ideal choice. This is particularly the case in populations with reduced slow-wave amplitudes, like older adults or psychiatric patients. We recommend the use of multidimensional prediction, especially in studies targeted at populations other than young and healthy individuals.
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Affiliation(s)
- Marina Wunderlin
- University Hospital of Old Age Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
| | - Thomas Koenig
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland,Interfaculty Research Cooperation ‐ Decoding SleepUniversity of BernBernSwitzerland
| | - Céline Zeller
- University Hospital of Old Age Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and PsychotherapyUniversity of BernBernSwitzerland,Interfaculty Research Cooperation ‐ Decoding SleepUniversity of BernBernSwitzerland
| | - Marc Alain Züst
- University Hospital of Old Age Psychiatry and PsychotherapyUniversity of BernBernSwitzerland
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18
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Schneider C, Hertenstein E, Fehér K, Moggi F, Berger T, Nissen C. : design, development and evaluation of a pragmatic behavioral treatment program for insomnia in inpatient psychiatric care. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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19
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Wunderlin M, Zeller C, Nissen C, Klöppel S, Züst M. Physiological responsiveness to phase-locked auditory stimulation during slow wave sleep predicts increases in episodic memory performance in older adults. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Nissen C, Kalantari F, Patel M, Prabhu A, Kesaria A, Kim T, Maraboyina S, Harrell L, Xia F, Lewis G. Analysis of Resident/Faculty Contour Concordance: A Potential Tool for Quantitative Assessment of Residents’ Performance in Target Volume Delineation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Oldenburg MA, Nissen C, Remark C. AmigA 4.0 in Flensburg – ein Update für die
Verknüpfung von Gesundheits- und
Arbeitsförderung. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- MA Oldenburg
- Europa-Universität Flensburg, Institut für
Gesundheits-, Ernährungs- und Sportwissenschaften, 24943 Flensburg,
Deutschland
- LVGFSH, 24113 Kiel, Deutschland
| | - C Nissen
- Jobcenter Flensburg, 24939 Flensburg, Deutschland
| | - C Remark
- Jobcenter Flensburg, 24939 Flensburg, Deutschland
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22
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Palagini L, Hertenstein E, Riemann D, Nissen C. Sleep, insomnia and mental health. J Sleep Res 2022; 31:e13628. [PMID: 35506356 DOI: 10.1111/jsr.13628] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 01/23/2023]
Abstract
While sleep serves important regulatory functions for mental health, sleep disturbances, in particular insomnia, may favour a state of allostatic overload impairing brain neuroplasticity and stress immune pathways, hence contributing to mental disorders. In this framework, the aim of this work was to link current understanding about insomnia mechanisms with current knowledge about mental health dysregulatory mechanisms. The focus of the present work was on mood, anxiety, and psychotic disorders, which represent important challenges in clinical practice. Literature searches were conducted on clinical, neurobiological, and therapeutic implications for insomnia comorbid with these mental disorders. Given the complexity and heterogeneity of the existing literature, we ended up with a narrative review. Insomnia may play an important role as a risk factor, a comorbid condition and transdiagnostic symptom for many mental disorders including mood/anxiety disorders and schizophrenia. Insomnia may also play a role as a marker of disrupted neuroplasticity contributing to dysregulation of different neurobiological mechanisms involved in these different mental conditions. In this framework, insomnia treatment may not only foster normal sleep processes but also the stress system, neuroinflammation and brain plasticity. Insomnia treatment may play an important preventive and neuroprotective role with cognitive behavioural therapy for insomnia being the treatment with important new evidence of efficacy for insomnia, psychopathology, and indices of disrupted neuroplasticity. On the other hand, pharmacological pathways for insomnia treatment in these mental conditions are still not well defined. Therapeutic options acting on melatonergic systems and new therapeutic options acting on orexinergic systems may represents interesting pathways of interventions that may open new windows on insomnia treatment in mental disorders.
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Affiliation(s)
- Laura Palagini
- Psychiatry Division, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Hauptstraße, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry, Psychiatric Specialties Division, Geneva University Hospitals (HUG), Geneva, Switzerland
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23
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Weber FC, Danker-Hopfe H, Dogan-Sander E, Frase L, Hansel A, Mauche N, Mikutta C, Nemeth D, Richter K, Schilling C, Sebestova M, Spath MM, Nissen C, Wetter TC. Restless Legs Syndrome Prevalence and Clinical Correlates Among Psychiatric Inpatients: A Multicenter Study. Front Psychiatry 2022; 13:846165. [PMID: 35370821 PMCID: PMC8967168 DOI: 10.3389/fpsyt.2022.846165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background There are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland. Methods This is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS. Results The prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS. Conclusions Clinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients.
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Affiliation(s)
- Franziska C. Weber
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Heidi Danker-Hopfe
- Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Competence Center of Sleep Medicine Berlin, Berlin, Germany
| | - Ezgi Dogan-Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg – Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Hansel
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg – Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Mauche
- Department of Psychiatry and Psychotherapy, University Leipzig, Medical Faculty, Leipzig, Germany
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Privatklinik Meiringen, Meiringen, Switzerland
| | - Diana Nemeth
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Kneginja Richter
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Claudia Schilling
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Marian M. Spath
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas C. Wetter
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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24
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Hertenstein E, Trinca E, Wunderlin M, Schneider CL, Züst MA, Fehér KD, Su T, VanStraten A, Berger T, Baglioni C, Johann A, Spiegelhalder K, Riemann D, Feige B, Nissen C. Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis. Sleep Med Rev 2022; 62:101597. [DOI: 10.1016/j.smrv.2022.101597] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/17/2022]
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25
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Hertenstein E, Trinca E, Schneider CL, Wunderlin M, Fehér K, Riemann D, Nissen C. Augmentation of Psychotherapy with Neurobiological Methods: Current State and Future Directions. Neuropsychobiology 2022; 80:437-453. [PMID: 33910218 DOI: 10.1159/000514564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychotherapy and pharmacotherapy are first-line treatments for mental disorders. Despite recent improvements, only approximately 50% of the patients reach sustained remission, indicating a need for novel developments. The main concept put forward in this systematic review and hypothesis article is the targeted co-administration of defined neurobiological interventions and specific psychotherapeutic techniques. METHODS We conducted a systematic literature search for randomized controlled trials comparing the efficacy of augmented psychotherapy to psychotherapy alone. RESULTS Thirty-five trials fulfilled the inclusion criteria. The majority (29 trials) used augmentation strategies such as D-cycloserine, yohimbine, or sleep to enhance the effects of exposure therapy for anxiety disorders. Fewer studies investigated noninvasive brain stimulation with the aim of improving cognitive control, psychedelic compounds with the aim of enhancing existentially oriented psychotherapy, and oxytocin to improve social communication during psychotherapy. Results demonstrate small augmentation effects for the enhancement of exposure therapy - however, some of the studies found negative results. Other methods are less thoroughly researched, and results are mixed. CONCLUSIONS This approach provides an open matrix for further research and has the potential to systematically guide future studies.
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Affiliation(s)
| | - Ersilia Trinca
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | | | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer Fehér
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Dieter Riemann
- Clinic of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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26
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Hertenstein E, Riemann D, Nissen C. Commentary on Brupbacher et al.: The effects of exercise on sleep in unipolar depression: A systematic review and network meta-analysis. Sleep Med Rev 2021; 60:101561. [PMID: 34740167 DOI: 10.1016/j.smrv.2021.101561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
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27
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Mikutta C, Wenke M, Spiegelhalder K, Hertenstein E, Maier JG, Schneider CL, Fehér K, Koenig J, Altorfer A, Riemann D, Nissen C, Feige B. Co-ordination of brain and heart oscillations during non-rapid eye movement sleep. J Sleep Res 2021; 31:e13466. [PMID: 34467582 PMCID: PMC9285890 DOI: 10.1111/jsr.13466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/26/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022]
Abstract
Oscillatory activities of the brain and heart show a strong variation across wakefulness and sleep. Separate lines of research indicate that non‐rapid eye movement (NREM) sleep is characterised by electroencephalographic slow oscillations (SO), sleep spindles, and phase–amplitude coupling of these oscillations (SO–spindle coupling), as well as an increase in high‐frequency heart rate variability (HF‐HRV), reflecting enhanced parasympathetic activity. The present study aimed to investigate further the potential coordination between brain and heart oscillations during NREM sleep. Data were derived from one sleep laboratory night with polysomnographic monitoring in 45 healthy participants (22 male, 23 female; mean age 37 years). The associations between the strength (modulation index [MI]) and phase direction of SO–spindle coupling (circular measure) and HF‐HRV during NREM sleep were investigated using linear modelling. First, a significant SO–spindle coupling (MI) was observed for all participants during NREM sleep, with spindle peaks preferentially occurring during the SO upstate (phase direction). Second, linear model analyses of NREM sleep showed a significant relationship between the MI and HF‐HRV (F = 20.1, r2 = 0.30, p < 0.001) and a tentative circular‐linear correlation between phase direction and HF‐HRV (F = 3.07, r2 = 0.12, p = 0.056). We demonstrated a co‐ordination between SO–spindle phase–amplitude coupling and HF‐HRV during NREM sleep, presumably related to parallel central nervous and peripheral vegetative arousal systems regulation. Further investigating the fine‐graded co‐ordination of brain and heart oscillations might improve our understanding of the links between sleep and cardiovascular health.
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Affiliation(s)
- Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Marion Wenke
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Jonathan G Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Kristoffer Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andreas Altorfer
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.,Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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28
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Wunderlin M, Züst MA, Hertenstein E, Fehér KD, Schneider CL, Klöppel S, Nissen C. Modulating overnight memory consolidation by acoustic stimulation during slow-wave sleep: a systematic review and meta-analysis. Sleep 2021; 44:6066545. [PMID: 33406249 DOI: 10.1093/sleep/zsaa296] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/12/2020] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES The low-frequency high-amplitude oscillations of slow-wave sleep (SWS) are considered to promote the consolidation of episodic memory. Previous research suggests that sleep slow waves can be entrained and enhanced by presenting short acoustic stimuli to the up-states of endogenous waves. Several studies have investigated the effects of these increases in slow-wave activity on overnight memory consolidation, with inconsistent results. The aim of this meta-analysis was to evaluate the accumulated evidence connecting acoustic stimulation during sleep to episodic memory consolidation. METHODS A systematic literature search was conducted in October 2020 using PubMed, Web of Science, and PsycInfo. The main study inclusion criteria were the application of acoustic slow wave enhancement in healthy participants and an assessment of pre- and post-sleep episodic memory performance. Effect sizes were pooled using a random-effects model. RESULTS A total of 10 primary studies with 11 experiments and 177 participants were included. Results showed a combined effect size (Hedges' g) of 0.25 (p = 0.07). Subgroup models based on young adults (n = 8), phase-locked stimulation approaches (n = 8), and their combination (n = 6) showed combined effect sizes of 0.31 (p = 0.051), 0.36 (p = 0.047), and 0.44 (p = 0.01), respectively. There was no indication of publication bias or bias in individual studies. CONCLUSIONS Acoustic enhancement of SWS tends to increase the overnight consolidation of episodic memory but effects remain small and-with the exception of subgroup models-at trend levels. Currently, the evidence is not sufficient to recommend the use of commercially available devices.
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Affiliation(s)
- Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Pinilla S, Cantisani A, Klöppel S, Strik W, Nissen C, Huwendiek S. Introducing a Psychiatry Clerkship Curriculum Based on Entrustable Professional Activities: an Explorative Pilot Study. Acad Psychiatry 2021; 45:354-359. [PMID: 33598804 PMCID: PMC8116264 DOI: 10.1007/s40596-021-01417-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The authors evaluated a reformed psychiatry clerkship curriculum based on entrustable professional activities (EPAs). METHODS The authors conducted an exploratory pilot study of a reformed clerkship curriculum based on EPAs. A novel workplace-based assessment format including an entrustment-supervision scale and curricular adaptations were introduced. The Kirkpatrick model was used to evaluate outcomes of the reformed clerkship curriculum on three levels (1 = acceptance, 2 = learning, 3 = change of behavior). RESULTS The pilot student cohort (n = 10) completed a questionnaire, 180 self-assessments (18 per student) on need for supervision, and 63 workplace-based assessments (6.3 per student, in 4 weeks). Level 1: high overall satisfaction with the clerkship (five-point Likert item: average, 4.9; range: 4.0-5.0). Level 2: the overall significant decrease in self-assessed need for supervision before and after the clerkship was two supervision levels (direct to indirect supervision; p < 0.05). The most frequently documented admissions included schizophrenic disorders (n = 11; 28%), affective disorders (n = 10; 25%), substance abuse disorders (n = 5; 13%), and anxiety and stress-related disorders (n = 5; 13%). Level 3: clinical supervisors used history taking, assessing the mental status, and documentation and presentation for workplace-based assessments. According to supervisors' ratings, there was a decreasing need for supervision from the first to last week of the clerkship. CONCLUSIONS Students reacted positively to the reformed clerkship curriculum. The workplace-based assessments with entrustment ratings appeared to support achievement of competency-based learning objectives. Better understanding of how to cover assessment of all core EPAs in the psychiatry clerkship is needed.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Institute for Medical Education, University of Bern, Bern, Switzerland.
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, University of Bern, Bern, Switzerland
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30
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Feige B, Baglioni C, Boehm P, Heinrich A, Trumm S, Benz F, Nissen C, Domschke K, Frase L, Riemann D. Event-related potentials in insomnia reflect altered perception of sleep. Sleep 2021; 44:6290313. [PMID: 34059920 DOI: 10.1093/sleep/zsab137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/17/2021] [Indexed: 01/28/2023] Open
Abstract
STUDY OBJECTIVES Insomnia is defined by the subjective complaint of poor sleep as well as daytime impairments. Since polysomnography (PSG) typically shows only modest sleep impairment, some still unidentified property of sleep, not mirrored in PSG, may be modified in insomnia.One possible mechanistic hypothesis is that insomnia patients may be more sensitive to inevitably occurring internal or external stimuli during the night, causing brief sleep disruptions then perceived as wake time. METHODS Auditory event-related potentials (ERP) to low intensity (50 dB SPL) synthesized guitar tones played continuously throughout two nights of polysomnographically registered sleep were obtained in fifty patients with insomnia disorder (ID, without comorbidities) and 50 age- and sex- matched good sleeper controls (GSC) for each sleep stage and NREM/REM cycle. Phasic and tonic REM were treated as separate stages. Latencies and amplitudes of components P1, N1 and P2 were measured and analyzed by multivariate repeated-measures ANCOVA including effects of group, night, cycle and age. RESULTS ID showed reduced P2 amplitudes relative to GSC specifically in phasic REM sleep. The same reduction also correlated with the amount of sleep misperception across groups. Independent component analysis showed a frontal negativity to contribute most to this group difference. CONCLUSIONS The present finding can be interpreted as increased mismatch negativity (MMN) in ID, reflecting automated detection of change in the auditory system and a concomitant orienting response. Specifically phasic REM sleep appears to be vulnerable to sensory afferences in ID patients, possibly contributing to the perception of being awake.
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Affiliation(s)
- Bernd Feige
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Chiara Baglioni
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Philipp Boehm
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Anna Heinrich
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Samuel Trumm
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Fee Benz
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katharina Domschke
- Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany.,Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Center for Basics in NeuroModulation (NeuroModulBasics), Breisacherstraße, Freiburg, Germany
| | - Lukas Frase
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
| | - Dieter Riemann
- Medical Center - University of Freiburg, Department of Psychiatry and Psychotherapy, Section of Clinical Psychology and Psychophysiology, Hauptstraße, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Breisacherstraße, Freiburg, Germany
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31
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Nissen C, Piosczyk H, Holz J, Maier JG, Frase L, Sterr A, Riemann D, Feige B. Sleep is more than rest for plasticity in the human cortex. Sleep 2021; 44:6047280. [PMID: 33401305 DOI: 10.1093/sleep/zsaa216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 09/11/2020] [Indexed: 11/12/2022] Open
Abstract
Sleep promotes adaptation of behavior and underlying neural plasticity in comparison to active wakefulness. However, the contribution of its two main characteristics, sleep-specific brain activity and reduced stimulus interference, remains unclear. We tested healthy humans on a texture discrimination task, a proxy for neural plasticity in primary visual cortex, in the morning and retested them in the afternoon after a period of daytime sleep, passive waking with maximally reduced interference, or active waking. Sleep restored performance in direct comparison to both passive and active waking, in which deterioration of performance across repeated within-day testing has been linked to synaptic saturation in the primary visual cortex. No difference between passive and active waking was observed. Control experiments indicated that deterioration across wakefulness was retinotopically specific to the trained visual field and not due to unspecific performance differences. The restorative effect of sleep correlated with time spent in NREM sleep and with electroencephalographic slow wave energy, which is thought to reflect renormalization of synaptic strength. The results indicate that sleep is more than a state of reduced stimulus interference, but that sleep-specific brain activity restores performance by actively refining cortical plasticity.
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Affiliation(s)
- Christoph Nissen
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Hannah Piosczyk
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Holz
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Psychology, University of Applied Police Sciences Baden-Württemberg, Villingen-Schwenningen, Germany
| | - Jonathan G Maier
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Annette Sterr
- School of Psychology, University of Surrey, Guildford, Surrey, UK
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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32
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Pinilla S, Kyrou A, Klöppel S, Strik W, Nissen C, Huwendiek S. Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study. BMC Med Educ 2021; 21:223. [PMID: 33882926 PMCID: PMC8059233 DOI: 10.1186/s12909-021-02637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship. METHODS We analyzed changes in self-entrustment ratings of students and the supervisors' ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation. RESULTS EPA 1 ("Take a patient's history"), EPA 2 ("Assess physical & mental status") and EPA 8 ("Document & present a clinical encounter") were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors' ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial. CONCLUSIONS Using formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students' development toward self-entrusted, indirect supervision levels.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland.
| | - Alexandra Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
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33
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Ferini-Strambi L, Auer R, Bjorvatn B, Castronovo V, Franco O, Gabutti L, Galbiati A, Hajak G, Khatami R, Kitajima T, McEvoy D, Nissen C, Perlis M, Pevernagie DA, Randerath W, Riemann D, Rizzo G, Van Someren E, Vgontzas A, Barazzoni F, Bassetti C. Insomnia disorder: clinical and research challenges for the 21st century. Eur J Neurol 2021; 28:2156-2167. [PMID: 33619858 DOI: 10.1111/ene.14784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Insomnia is a common and debilitating disorder that is frequently associated with important consequences for physical health and well-being. METHODS An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field of insomnia and identified future priorities. RESULTS The association of trajectories of insomnia with subsequent quality of life, health and mortality should be investigated in large populations. Prospective health economics studies by separating the costs driven specifically by insomnia and costs attributable to its long-term effects are needed. Ignoring the heterogeneity of insomnia patients leads to inadequate diagnosis and inefficient treatment. Individualized interventions should be promoted. More data are needed on both the impact of sleep on overnight effects, such as emotion regulation, and the potential compensatory effort to counteract diurnal impairments. Another gap is the definition of neurocognitive deficits in insomnia patients compared to normal subjects after chronic sleep loss. There are also a number of key gaps related to insomnia treatment. Expert guidelines indicate cognitive-behavioural therapy for insomnia as first-line treatment. They neglect, however, the reality of major healthcare providers. The role of combined therapy, cognitive-behavioural therapy for insomnia plus pharmacological treatment, should be evaluated more extensively. CONCLUSION Whilst insomnia disorder might affect large proportions of the population, there are a number of significant gaps in the epidemiological/clinical/research studies carried out to date. In particular, the identification of different insomnia phenotypes could allow more cost-effective and efficient therapies.
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Affiliation(s)
- Luigi Ferini-Strambi
- "Vita-Salute" San Raffaele University, Milan, Italy.,Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Vincenza Castronovo
- Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Oscar Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Luca Gabutti
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
| | - Andrea Galbiati
- "Vita-Salute" San Raffaele University, Milan, Italy.,Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Goeran Hajak
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Social Foundation Bamberg, Bamberg, Germany
| | - Ramin Khatami
- Center of Sleep Medicine, Sleep Research and Epilepsy, Klinik Barmelweid, Barmelweid Academy, Barmelweid, Switzerland
| | - Tsuyoshi Kitajima
- Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Japan
| | - Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Perlis
- Department of Psychiatry, Behavioral Sleep Medicine Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dirk A Pevernagie
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | | | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Eus Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.,Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - Alexandros Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Penn State Hershey Medical Center, College of Medicine, Pennsylvania State University, Hershey, PA, USA
| | | | - Claudio Bassetti
- Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Sechenov University, Moscow, Russia
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Geiser T, Hertenstein E, Fehér K, Maier JG, Schneider CL, Züst MA, Wunderlin M, Mikutta C, Klöppel S, Nissen C. Targeting Arousal and Sleep through Noninvasive Brain Stimulation to Improve Mental Health. Neuropsychobiology 2021; 79:284-292. [PMID: 32408296 DOI: 10.1159/000507372] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/14/2020] [Indexed: 01/29/2023]
Abstract
Arousal and sleep represent fundamental physiological domains, and alterations in the form of insomnia (difficulty falling or staying asleep) or hypersomnia (increased propensity for falling asleep or increased sleep duration) are prevalent clinical problems. Current first-line treatments include psychotherapy and pharmacotherapy. Despite significant success, a number of patients do not benefit sufficiently. Progress is limited by an incomplete understanding of the -neurobiology of insomnia and hypersomnia. This work summarizes current concepts of the regulation of arousal and sleep and its modulation through noninvasive brain stimulation (NIBS), including transcranial magnetic, current, and auditory stimulation. Particularly, we suggest: (1) characterization of patients with sleep problems - across diagnostic entities of mental disorders - based on specific alterations of sleep, including alterations of sleep slow waves, sleep spindles, cross-frequency coupling of brain oscillations, local sleep-wake regulation, and REM sleep and (2) targeting these with specific NIBS techniques. While evidence is accumulating that the modulation of specific alterations of sleep through NIBS is feasible, it remains to be tested whether this translates to clinically relevant effects and new treatment developments.
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Affiliation(s)
- Tim Geiser
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jonathan G Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Privatklinik Meiringen, Meiringen, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland,
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Pinilla S, Cantisani A, Klöppel S, Strik W, Nissen C, Huwendiek S. Suggestions for Improving the Assessment of a Learning Management System Used for Clinical Curriculum Development [Response to Letter]. Adv Med Educ Pract 2021; 12:285-286. [PMID: 33776505 PMCID: PMC7989053 DOI: 10.2147/amep.s311170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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Pinilla S, Lenouvel E, Cantisani A, Klöppel S, Strik W, Huwendiek S, Nissen C. Working with entrustable professional activities in clinical education in undergraduate medical education: a scoping review. BMC Med Educ 2021; 21:172. [PMID: 33740970 PMCID: PMC7980680 DOI: 10.1186/s12909-021-02608-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/10/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are increasingly used in undergraduate medical education (UME). We conducted a scoping review to summarize the evidence for the use of EPAs in clinical rotations in UME. METHODS We searched multiple databases for scoping reviews based on the PRISMA guidelines for articles reporting qualitative and quantitative research, as well as conceptual and curriculum development reports, on EPAs in UME clinical rotations. RESULTS We identified 3309 records by searching through multiple databases. After the removal of duplicates, 1858 reports were screened. A total of 36 articles were used for data extraction. Of these, 47% reported on EPA and EPA-based curriculum development for clerkships, 50% reported on implementation strategies, and 53% reported on assessment methods and tools used in clerkships. Validity frameworks for developing EPAs in the context of clerkships were inconsistent. Several specialties reported feasible implementation strategies for EPA-based clerkship curricula, however, these required additional faculty time and resources. Limited exposure to clinical activities was identified as a barrier to relevant learning experiences. Educators used nationally defined, or specialty-specific EPAs, and a range of entrustability and supervision scales. We found only one study that used an empirical research approach for EPA assessment. One article reported on the earlier advancement of trainees from UME to graduate medical education based on summative entrustment decisions. CONCLUSIONS There is emerging evidence concerning how EPAs can be effectively introduced to clinical training in UME. Specialty-specific, nested EPAs with context-adapted, entrustment-supervision scales might be helpful in better leveraging their formative assessment potential.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Eric Lenouvel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Pinilla S, Kyrou A, Maissen N, Klöppel S, Strik W, Nissen C, Huwendiek S. Entrustment decisions and the clinical team: A case study of early clinical students. Med Educ 2021; 55:365-375. [PMID: 33301632 DOI: 10.1111/medu.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE Clinical learning contexts influence how medical students engage with entrustment decisions. However, it is unclear how students and health care team members perceive the entrustment decision process. This study explored which factors students and team members consider relevant to entrustment decisions in early clinical rotations. METHODS The authors conducted a case study at an academic teaching hospital, interviewing 28 medical students and four health care team members during the clerkship year. Within a social constructivist epistemology, we explored students' and health care team members' perceptions of ad hoc entrustment decisions using semi-structured interviews. Transcripts from the interviews and notes from feedback rounds with students were used for analysis. RESULTS Medical students in their core clerkship year perceived clinical residents as critical educational gatekeepers and key facilitators of entrustment decisions. Another important theme emerged around students' motivation, initiative and willingness to engage with the health care team and patients. Students actively engaged in trust formation processes with different health care team members. The entrustment decision process was perceived as multilateral and dynamic, involving all health care team members and patients. Multiple entrusting supervisors for clerkship students, including nurses and psychologists, emerged from our interview data. They assumed an active role in negotiating entrustment decisions both with and for clerkship students, either facilitating or hindering opportunities. The entrustment decisions emerged as a result of a multifaceted supervisor network interaction. CONCLUSIONS Supervising residents' ability to integrate students into clinical teams seems to be a critical factor in facilitating entrustment opportunities for clinical activities. Students' active management of informal supervisor networks of health care team members and these team members' willingness to assume responsibility for the students' education emerged as relevant aspects for ad hoc entrustment. Our data suggest that supervision from different health professionals is beneficial for clinical education of medical students and merits further exploration.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alexandra Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Norina Maissen
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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Fehér KD, Wunderlin M, Maier JG, Hertenstein E, Schneider CL, Mikutta C, Züst MA, Klöppel S, Nissen C. Shaping the slow waves of sleep: A systematic and integrative review of sleep slow wave modulation in humans using non-invasive brain stimulation. Sleep Med Rev 2021; 58:101438. [PMID: 33582581 DOI: 10.1016/j.smrv.2021.101438] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 01/19/2023]
Abstract
The experimental study of electroencephalographic slow wave sleep (SWS) stretches over more than half a century and has corroborated its importance for basic physiological processes, such as brain plasticity, metabolism and immune system functioning. Alterations of SWS in aging or pathological conditions suggest that modulating SWS might constitute a window for clinically relevant interventions. This work provides a systematic and integrative review of SWS modulation through non-invasive brain stimulation in humans. A literature search using PubMed, conducted in May 2020, identified 3220 studies, of which 82 fulfilled inclusion criteria. Three approaches have been adopted to modulate the macro- and microstructure of SWS, namely auditory, transcranial electrical and transcranial magnetic stimulation. Our current knowledge about the modulatory mechanisms, the space of stimulation parameters and the physiological and behavioral effects are reported and evaluated. The integration of findings suggests that sleep slow wave modulation bears the potential to promote our understanding of the functions of SWS and to develop new treatments for conditions of disrupted SWS.
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Affiliation(s)
- Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Jonathan G Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Christian Mikutta
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Privatklinik Meiringen, Meiringen, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
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Pinilla S, Cantisani A, Klöppel S, Strik W, Nissen C, Huwendiek S. Curriculum Development with the Implementation of an Open-Source Learning Management System for Training Early Clinical Students: An Educational Design Research Study. Adv Med Educ Pract 2021; 12:53-61. [PMID: 33488137 PMCID: PMC7814239 DOI: 10.2147/amep.s284974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Learning management systems (LMSs) have not been explored from an educational design research (EDR) perspective for developing clinical curricula and supporting novice clinical students with self-regulated learning during their early clinical rotations. METHODS An EDR approach was used to inform a de novo implementation of an LMS during an early clinical rotation of medical students. The EDR consisted of three phases: analysis and exploration; design and construction; and evaluation and reflection. Process and evaluation data (including academic years 2018 and 2019) from two student cohorts (total n = 190, 107 without and 83 with LMS exposure) at one academic teaching hospital were analyzed. RESULTS Learning theories and concepts of self-regulated learning were used to develop and implement an LMS clerkship prototype. For design and construction, the maturing prototype design included flipped-classroom elements, in-class activation, voluntary digital self-assessments, and clinical teaching videos. For evaluation and reflection, global satisfaction improvement was significant (from 3.9 to 4.4 on a 5-point Likert scale, p < 0.05). There was a positive evaluation trend for all evaluation items related to learning climate, self-regulated learning, and perceived usefulness of the LMS prototype; however, these changes were not statistically significant. The teaching hospital also improved its ranking after the introduction of the LMS prototype. Nearly all students (94%) used the LMS material. The average number of times the LMS course was accessed per student was 70 (range: 7-172), and the average duration students spent online was 58 minutes (range: 9-165). CONCLUSION Our data indicate that using an EDR approach was helpful for systematically introducing an LMS in a clerkship curriculum informed by learning theory. Our evidence-oriented curriculum reform was associated with higher student satisfaction and appeared to support self-regulated learning in the workplace. Further research should explore which elements of an LMS most effectively help to achieve educational outcomes.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for Medical Education, Department for Assessment and Evaluation, University of Bern, Bern, Switzerland
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40
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Pinilla S, Matthes O, Gehret A, Huwendiek S, Lenouvel E, Lindert S, Marty AP, Nick B, Nissen C, Schneeberger A, Stocker L, Wallies M, Weidt S, Weiss-Breckwoldt A, Klöppel S. [Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept]. Praxis (Bern 1994) 2021; 110:30-36. [PMID: 33406929 DOI: 10.1024/1661-8157/a003601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Entrustable Professional Activities in Graduate Medical Education in Psychiatry: A Promising Concept Abstract. Entrustable Professional Activities (EPAs) are competency-based learning goals derived from observable clinical activities. In undergraduate medical education, they have now been adopted throughout Switzerland as part of the so-called PROFILES catalog (Principal Relevant Objectives and Framework for Integrated Learning and Education in Switzerland). The nine core EPAs to be mastered in undergraduate medical education can serve as a basis for introducing EPAs in graduate medical education as well. We will discuss this approach in the context of graduate medical education in psychiatry and psychotherapy from the perspective of different training contexts and a pilot example. In this position paper, we describe a promising opportunity to improve graduate medical training through the implementation of EPAs, both in terms of the quality of training and thus of patient care, as well as in terms of the attractiveness of the specialty for future residents.
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Affiliation(s)
- Severin Pinilla
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern
- Institut für Medizinische Lehre (IML), Abteilung für Assessment und Evaluation, Universität Bern
- Geteilte Erstautorenschaft
| | - Oliver Matthes
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
- Geteilte Erstautorenschaft
| | | | - Sören Huwendiek
- Institut für Medizinische Lehre (IML), Abteilung für Assessment und Evaluation, Universität Bern
| | - Eric Lenouvel
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern
| | - Susanne Lindert
- Clienia Schlössli, Privatklinik und Lehrkrankenhaus der Universität Zürich, Oetwil am See/Zürich
| | | | - Beat Nick
- Psychiatrische Dienste der Spitäler AG, Solothurn, Psychiatrische Dienste der Spitäler AG Solothurn, Präsident der Prüfungskommission und Mitglied der Kommission Weiter- und Fortbildung (SKWF), Schweizerische Gesellschaft für Psychiatrie und Psychotherapie (SGPP)
- Ressort Qualität der Ständigen Kommission Weiter- und Fortbildung (SKWF), Schweizerische Gesellschaft für Psychiatrie und Psychotherapie (SGPP)
| | - Christoph Nissen
- Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern
| | | | - Lea Stocker
- Akuttagesklinik, Psychiatrische Universitätsklinik Zürich
| | - Michael Wallies
- Privatklinik für Psychiatrie und Psychotherapie, Clienia Littenheid
| | | | | | - Stefan Klöppel
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern
- Ressort Qualität der Ständigen Kommission Weiter- und Fortbildung (SKWF), Schweizerische Gesellschaft für Psychiatrie und Psychotherapie (SGPP)
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Habich A, Fehér KD, Antonenko D, Boraxbekk CJ, Flöel A, Nissen C, Siebner HR, Thielscher A, Klöppel S. Stimulating aged brains with transcranial direct current stimulation: Opportunities and challenges. Psychiatry Res Neuroimaging 2020; 306:111179. [PMID: 32972813 DOI: 10.1016/j.pscychresns.2020.111179] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/30/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Ageing involves significant neurophysiological changes that are both systematic while at the same time exhibiting divergent trajectories across individuals. These changes underlie cognitive impairments in elderly while also affecting the response of aged brains to interventions like transcranial direct current stimulation (tDCS). While the cognitive benefits of tDCS are more variable in elderly, older adults also respond differently to stimulation protocols compared to young adults. The age-related neurophysiological changes influencing the responsiveness to tDCS remain to be addressed in-depth. We review and discuss the premise that, in comparison to the better calibrated brain networks present in young adults, aged systems perform further away from a homoeostatic set-point. We argue that this age-related neurophysiological deviation from the homoeostatic optimum extends the leeway for tDCS to modulate the aged brain. This promotes the potency of immediate tDCS effects to induce directional plastic changes towards the homoeostatic equilibrium despite the impaired plasticity induction in elderly. We also consider how age-related neurophysiological changes pose specific challenges for tDCS that necessitate proper adaptations of stimulation protocols. Appreciating the distinctive properties of aged brains and the accompanying adjustment of stimulation parameters can increase the potency and reliability of tDCS as a treatment avenue in older adults.
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Affiliation(s)
- Annegret Habich
- University Hospital of Old Age Psychiatry and Psychotherpa, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland; Faculty of Biology, University of Freiburg, Schänzlestrasse 1, 79104 Freiburg, Germany.
| | - Kristoffer D Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland
| | - Daria Antonenko
- Department of Neurology, University of Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Carl-Johan Boraxbekk
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Østvej, 2650 Hvidovre, Denmark; Department of Radiation Sciences, Umeå University, 90187 Umeå, Sweden; Institute of Sports Medicine Copenhagen (ISMC), Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Agnes Flöel
- Department of Neurology, University of Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; German Center for Neurodegenerative Diseases, Ellernholzstraße 1-2, 17489 Greifswald, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland; Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Hauptstraße 5, 79104 Freiburg, Germany
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Østvej, 2650 Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Nørre Allé 20, 2200 Copenhagen, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Østvej, 2650 Hvidovre, Denmark; Department of Electrical Engineering, Technical University of Denmark, Ørsteds Pl. 348, 2800 Kgs. Lyngby, Denmark
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherpa, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland
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Wunderlin M, Züst MA, Fehér KD, Klöppel S, Nissen C. The role of slow wave sleep in the development of dementia and its potential for preventative interventions. Psychiatry Res Neuroimaging 2020; 306:111178. [PMID: 32919869 DOI: 10.1016/j.pscychresns.2020.111178] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 07/02/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022]
Abstract
The increasing incidence rate of dementia underlines the necessity to identify early biomarkers of imminent cognitive decline. Recent findings suggest that cognitive decline and the pathophysiology of Alzheimer's disease are closely linked to disruptions in slow wave sleep (SWS) - the deepest sleep stage. SWS is essential for memory functions and displays a potentially causal and bidirectional link to the accumulation of amyloid beta deposition. Accordingly, improving SWS in older adults - especially when at risk for dementia - might slow down the rate of cognitive decline. Recent work suggests that SWS can be improved by specifically targeting the electrophysiological peaks of the slow waves with acoustic stimulation. In older adults, this approach is still fairly new and accompanied by challenges posed by the specific complexity of their sleep physiology, like lower amplitude slow waves and fragmented sleep architecture. We suggest an approach that tackles these issues and attempts to re-instate a sleep physiology that resembles a younger, healthier brain. With enough SWS of high quality, metabolic clearance and memory functions could benefit and help slowing the process of cognitive aging. Ultimately, acoustic stimulation to enhance SWS could serve as a cost-effective, non-invasive tool to combat cognitive decline.
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Affiliation(s)
- Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
| | - Marc Alain Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Kristoffer Daniel Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Switzerland, Bolligenstrasse 111, 3000 Bern 60, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland, Bolligenstrasse 111, 3000 Bern 60, Switzerland
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Schneider CL, Hertenstein E, Fehér K, Maier JG, Cantisani A, Moggi F, Berger T, Nissen C. Become your own SLEEPexpert: design, implementation, and preliminary evaluation of a pragmatic behavioral treatment program for insomnia in inpatient psychiatric care. Sleep Adv 2020; 1:zpaa005. [PMID: 37192879 PMCID: PMC10104352 DOI: 10.1093/sleepadvances/zpaa005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/01/2020] [Indexed: 05/17/2023]
Abstract
Study Objectives The majority of patients with mental disorders suffer from insomnia, associated with adverse health outcomes. Cognitive behavioral therapy for insomnia (CBT-I) represents the first-line treatment, but is too complex for severely ill patients and not systematically implemented in inpatient psychiatric care. This project aimed to develop a pragmatic behavioral treatment program that empowers inpatients with severe mental disorders to take care of their own sleep health. Methods CBT-I was adapted based on implementation research involving 24 inpatients with psychiatric disorders across diagnostic entities and comorbid insomnia and 30 health care providers at the University Hospital of Psychiatry and Psychotherapy, Bern. The program was implemented and evaluated by 15 patients and 22 health care providers based on interviews and questionnaires before participation and prior to discharge. Results Implementation research resulted in the SLEEPexpert intervention, centering on bedtime restriction and circadian adaptation in three phases; therapist-guided treatment initiation, self-management with nursing support, and self-management. Evaluative pre-post assessments in 15 patients demonstrated feasibility. Time in bed decreased by 60 minutes (520 ± 105.3 vs. 460 ± 78.1, p = 0.031, d = 0.6) and total sleep time increased by around 45 minutes (331 ± 110.6 vs. 375 ± 74.6, p = 0.09, d = 0.5), resulting in increased sleep efficiency (65.3 ± 21.8 vs. 81.9 ± 11.2%, p = 0.011, d = 0.8). Patients improved on the Insomnia Severity Index (18.3 ± 4.6 vs. 11.4 ± 4.4, p < 0.001, d = 1.2) and Pittsburgh Sleep Quality Index (12.9 ± 3.8 vs. 10.3 ± 3.3, p = 0.031, d = 0.6). Conclusions We propose a new pragmatic behavioral treatment program (SLEEPexpert) customized to the needs of patients and health care providers in inpatient psychiatric care. Data demonstrate feasibility. An improvement of insomnia severity was observed, but a control comparison is needed to further test for efficacy.
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Affiliation(s)
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer Fehér
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jonathan Gabriel Maier
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea Cantisani
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Kuhn M, Maier JG, Wolf E, Mainberger F, Feige B, Maywald S, Bredl A, Michel M, Sendelbach N, Normann C, Klöppel S, Eckert A, Riemann D, Nissen C. Indices of cortical plasticity after therapeutic sleep deprivation in patients with major depressive disorder. J Affect Disord 2020; 277:425-435. [PMID: 32866801 DOI: 10.1016/j.jad.2020.08.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/02/2020] [Accepted: 08/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Therapeutic sleep deprivation (SD) presents a unique paradigm to study the neurobiology of major depressive disorder (MDD). However, the rapid antidepressant mechanism, which differs from today's slow first-line treatments, is not sufficiently understood. We recently integrated two prominent hypotheses of MDD and sleep, the synaptic plasticity hypothesis of MDD and the synaptic homeostasis hypothesis of sleep-wake regulation, into a synaptic plasticity model of therapeutic SD in MDD. Here, we further tested this model positing that homeostatically elevating net synaptic strength through therapeutic SD shifts the initially deficient inducibility of associative synaptic long-term potentiation (LTP)-like plasticity in patients with MDD into a more favorable window of associative plasticity. METHODS We used paired associative stimulation (PAS), a transcranial magnetic stimulation protocol (TMS), to quantify cortical LTP-like plasticity after one night of therapeutic sleep deprivation in 28 patients with MDD. RESULTS We demonstrate a significantly different inducibility of associative plasticity in clinical responders to therapeutic SD (> 50% improvement on the 6-item Hamilton-Rating-Scale for Depression, n=13) compared to non-responders (n=15), which was driven by a long-term depression (LTD)-like response in SD-non-responders. Indices of global net synaptic strength (wake EEG theta activity, intracortical inhibition and BDNF serum levels) were increased after SD in both groups, with responders showing a generally lower intracortical inhibition than non-responders. LIMITATIONS Repetitive assessments prior to and after treatment would be needed to further determine potential mechanisms. CONCLUSION After a night of therapeutic SD, clinical responders show a significantly higher inducibility of associative LTP-like plasticity than non-responders.
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Affiliation(s)
- Marion Kuhn
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jonathan G Maier
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Elias Wolf
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Florian Mainberger
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sarah Maywald
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Aliza Bredl
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Maike Michel
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nicola Sendelbach
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anne Eckert
- Neurobiology Lab for Brain Aging and Mental Health, Transfaculty Research Platform, Molecular & Cognitive Neuroscience, University of Basel, Basel, Switzerland; Psychiatric University Clinics, University of Basel, Basel, Switzerland
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
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45
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Denecke K, Schneider CL, Hertenstein E, Nissen C. SLEEPexpert App - A Mobile Application to Support Insomnia Treatment for Patients with Severe Psychiatric Disorders. Stud Health Technol Inform 2020; 275:42-46. [PMID: 33227737 DOI: 10.3233/shti200691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cognitive behavior therapy for insomnia (CBT-I) is the first-line treatment for patients with insomnia disorder, including patients with severe mental disorders and comorbid insomnia. However, CBT-I is not sufficiently implemented in acute psychiatry settings. To make this treatment more accessible, we are currently adapting CBT-I to the needs of patients with severe psychiatric disorders in the form of a treatment program entitled SLEEPexpert. A core element of SLEEPexpert is keeping a sleep diary and restricting time in bed to increase sleep pressure. Here, we present a mobile application which supports the implementation of SLEEPexpert. The app is kept very simple, specifically designed for the target user group, and offers four main functionalities: entering information into the sleep diary, calculating the sleep efficiency and adapting the sleep window, delivering information on sleep and sleep disorders and accessing the recorded data in the sleep diary. Currently, we are preparing a usability test for the app aiming at fixing usability issues before running a clinical trial to assess the efficacy of this mHealth intervention.
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Affiliation(s)
| | - Carlotta L Schneider
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Elisabeth Hertenstein
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
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46
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Bielinski LL, Krieger T, Moggi F, Trimpop L, Willutzki U, Nissen C, Berger T. REMOTION Blended Transdiagnostic Intervention for Symptom Reduction and Improvement of Emotion Regulation in an Outpatient Psychotherapeutic Setting: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e20936. [PMID: 33180026 PMCID: PMC7691093 DOI: 10.2196/20936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/10/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emotion regulation has been identified as an important transdiagnostic factor relevant to the treatment of mental health disorders. Many empirically validated psychotherapeutic treatments incorporate elements targeting emotion regulation. Most of these treatment approaches are conceptualized as standard face-to-face treatments not as blended treatments, which include an internet-based intervention. OBJECTIVE The aim of this study is to examine, for the first time, a new internet-based intervention-REMOTION-that will be provided transdiagnostically, as an add-on to psychotherapy, to provide a blended treatment format. METHODS A total of 70 participants will be assigned (1:1 allocation ratio) to either the intervention group (REMOTION + psychotherapy) or the treatment-as-usual group that receives psychotherapy alone. To maximize external validity, a typical outpatient treatment sample of patients diagnosed with a range of disorders such as depression, anxiety disorders, and adjustment disorder will be recruited from a university outpatient clinic. Patients with bipolar disorder, psychotic disorders, or acute suicidality will be excluded from the study. The feasibility and potential effectiveness of the intervention will be examined by assessing data at baseline, 6 weeks (post), and 12 weeks (follow-up). The primary outcome is general symptom severity, assessed with the Brief Symptom Inventory. Secondary outcomes are emotion regulation, depressive symptoms, anxiety symptoms, health related quality of life, well-being, and a variety of feasibility parameters. Quantitative data will be analyzed on an intention-to-treat basis. RESULTS Participant recruitment and data collection started in February 2020, and as of November 2020, are ongoing. Results for the study are expected in 2022. CONCLUSIONS This pilot randomized controlled trial will inform future studies using transdiagnostic blended treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04262726; http://clinicaltrials.gov/ct2/show/NCT04262726. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20936.
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Affiliation(s)
- Laura Luisa Bielinski
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leonie Trimpop
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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47
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Linder S, Duss SB, Dvořák C, Merlo C, Essig S, Tal K, Del Giovane C, Syrogiannouli L, Heinzer R, Nissen C, Bassetti CLA, Auer R, Maire M. Treating insomnia in Swiss primary care practices: A survey study based on case vignettes. J Sleep Res 2020; 30:e13169. [PMID: 32951295 DOI: 10.1111/jsr.13169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022]
Abstract
Guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as first-line treatment for chronic insomnia, but it is not clear how many primary care physicians (PCPs) in Switzerland prescribe this treatment. We created a survey that asked PCPs how they would treat chronic insomnia and how much they knew about CBT-I. The survey included two case vignettes that described patients with chronic insomnia, one with and one without comorbid depression. PCPs also answered general questions about treating chronic insomnia and about CBT-I and CBT-I providers. Of the 820 Swiss PCPs we invited, 395 (48%) completed the survey (mean age 54 years; 70% male); 87% of PCPs prescribed sleep hygiene and 65% phytopharmaceuticals for the patient who had only chronic insomnia; 95% prescribed antidepressants for the patient who had comorbid depression. In each case, 20% of PCPs prescribed benzodiazepines or benzodiazepine receptor agonists, 8% prescribed CBT-I, 68% said they knew little about CBT-I, and 78% did not know a CBT-I provider. In the clinical case vignettes, most PCPs treated chronic insomnia with phytopharmaceuticals and sleep hygiene despite their lack of efficacy, but PCPs rarely prescribed CBT-I, felt they knew little about it, and usually knew no CBT-I providers. PCPs need more information about the benefits of CBT-I and local CBT-I providers and dedicated initiatives to implement CBT-I in order to reduce the number of patients who are prescribed ineffective or potentially harmful medications.
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Affiliation(s)
- Stefanie Linder
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Simone B Duss
- Department of Neurology, Sleep-Wake-Epilepsy Center, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| | - Charles Dvořák
- Sentinella - Swiss Epidemiological System, Federal Office of Public Health FOPH, Bern, Switzerland
| | - Christoph Merlo
- Sentinella - Swiss Epidemiological System, Federal Office of Public Health FOPH, Bern, Switzerland.,Institute of Primary and Community Care, Lucerne, Switzerland
| | - Stefan Essig
- Sentinella - Swiss Epidemiological System, Federal Office of Public Health FOPH, Bern, Switzerland.,Institute of Primary and Community Care, Lucerne, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Raphael Heinzer
- Pulmonary Department, Center for Investigation and Research in Sleep, University Hospital of Lausanne, Lausanne, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Sleep-Wake-Epilepsy Center, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.,Neurology Department, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Micheline Maire
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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48
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Frase L, Acker J, Cohrs S, Danker-Hopfe H, Frohn C, Göder R, Mauche N, Norra C, Pollmächer T, Richter K, Riemann D, Schilling C, Weeß HG, Wetter TC, Nissen C. [Recommendations on performing polygraphy or polysomnography in the fields of psychiatry and psychotherapy : Position paper of the working group on sleep medicine of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. Nervenarzt 2020; 91:843-853. [PMID: 31853578 DOI: 10.1007/s00115-019-00855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Difficulties in falling asleep and maintaining sleep, nonrestorative sleep and decreased daytime wakefulness represent very common but relatively unspecific health complaints. Around 100 specific sleep-related disorders will be classified in their own major chap. 7 (sleep wake disorders) for the first time in the upcoming 11th version of the International Classification of Diseases (ICD 11). With respect to the disciplines of psychiatry and psychotherapy there is a bidirectional relationship between mental health and sleep wake disorders. Sleep wake disorders can be an independent risk factor for the onset of a mental disorder and have a negative influence on the course of the disease. In addition, sleep wake disorders can also precede a mental disease as an early symptom and therefore be an important indication for early recognition. Many sleep wake disorders can be diagnosed based on the anamnesis and routine clinical investigations. In special cases, examination in a specialized sleep laboratory and treatment in a sleep medicine center following a staged care approach can be mandatory. Polysomnography represents the gold standard for the differential diagnostics; however, there is no legal foundation in the field of neuropsychiatric disorders for remuneration in the German healthcare system. This review summarizes the current guidelines with respect to the criteria for an investigation in a sleep laboratory from the perspective of the disciplines of psychiatry and psychotherapy. From this the requirements for guideline-conform diagnostics and treatment are derived.
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Affiliation(s)
- Lukas Frase
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland.
| | - Jens Acker
- Klinik für Schlafmedizin, Bad Zurzach, Schweiz
| | - Stefan Cohrs
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Rostock, Rostock, Deutschland
| | - Heidi Danker-Hopfe
- Kompetenzzentrum Schlafmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Corinna Frohn
- Medizinisches Versorgungszentrum Bethanien, Solingen, Deutschland
| | - Robert Göder
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Nicole Mauche
- Zentrum für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - Christine Norra
- LWL-Klinik Paderborn, Psychiatrie Psychotherapie Psychosomatik, Medizinische Fakultät Ruhr-Universität Bochum, Bochum, Deutschland
| | - Thomas Pollmächer
- Zentrum für psychische Gesundheit, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | - Kneginja Richter
- Universitätsklinik für Psychiatrie und Psychotherapie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - Dieter Riemann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland
| | - Claudia Schilling
- Zentralinstitut für Seelische Gesundheit, Schlaflabor, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Hans-Günter Weeß
- Interdisziplinäres Schlafzentrum am Pfalzklinikum, Klingenmünster, Deutschland
| | - Thomas C Wetter
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum, Schlafmedizinisches Zentrum, Regensburg, Deutschland
| | - Christoph Nissen
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland
- Universitätsklinik für Psychiatrie und Psychotherapie, Bern, Schweiz
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49
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Schmid SR, Nissen C, Riemann D, Spiegelhalder K, Frase L. Auditorische Stimulation während des Schlafs. Somnologie 2020. [DOI: 10.1007/s11818-020-00255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungDie Insomnie, d. h. eine Ein- und/oder Durchschlafstörung, die sich negativ auf die Leistungsfähigkeit und Tagesbefindlichkeit auswirkt, ist eine der häufigsten Erkrankungen in der Allgemeinbevölkerung. Sie wird derzeit meistens pharmakologisch und/oder psychotherapeutisch behandelt, wobei die pharmakologische Behandlung mit Benzodiazepin-Rezeptor-Agonisten zu Abhängigkeit führen kann und die Verfügbarkeit von für die Insomnie-Therapie ausgebildeten Psychotherapeuten momentan nicht in ausreichendem Maße gegeben ist. Durch innovative Behandlungsmethoden könnte hier eine Versorgungslücke effektiv geschlossen werden. Hierzu zählt die auditorische Stimulation, welche vorhandene Sinneskanäle nutzt, um den Schlaf zu beeinflussen. Bisher wurde die auditorische Stimulation vor allem zur Untersuchung von Prozessen der Gedächtniskonsolidierung bei gesunden Probanden angewendet, wobei erfolgreich eine Erhöhung langsamer Oszillationen erreicht wurde, welche vor allem während des Tiefschlafs auftreten. Erste Befunde und sekundäre Outcome-Parameter liefern Hinweise, dass die Potenzierung langsamer Oszillationen durch auditorische Stimulation den Schlaf vertiefen kann, jedoch wurde hierzu bislang keine Studie mit Insomniepatienten durchgeführt. Weitere Forschung bezüglich des Einflusses der Potenzierung langsamer Oszillationen auf die Linderung von Ein- und Durchschlafproblemen bei vorliegender nichtorganischer Insomnie erscheint daher geboten zu sein, um der hohen Beschwerdelast dieser Patientengruppe entgegenzuwirken.
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50
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Johann AF, Hertenstein E, Feige B, Akram U, Holub F, Baglioni C, Domschke K, Schramm E, Nissen C, Kyle SD, Riemann D, Biermann J, Spiegelhalder K. Cognitive behavioural therapy for insomnia does not appear to have a substantial impact on early markers of cardiovascular disease: A preliminary randomized controlled trial. J Sleep Res 2020; 29:e13102. [PMID: 32596882 DOI: 10.1111/jsr.13102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
According to the World Health Organization, cardiovascular diseases are the leading cause of death in the world. Therefore, early prevention of these diseases is a public health priority. Epidemiological data suggest that insomnia may be a modifiable risk factor for cardiovascular diseases. A randomized controlled trial in a sample of insomnia patients without cardiovascular disease was conducted to investigate the effects of insomnia treatment on early markers of cardiovascular diseases assessed by 24-hr ambulatory blood pressure, heart rate and heart rate variability monitoring, and morning fasting blood samples. Forty-six patients with insomnia disorder were randomized to cognitive behavioural therapy for insomnia (CBT-I; n = 23) or a waitlist control condition (n = 23). Contrary to the hypothesis, intention-to-treat analyses did not show any significant treatment effects on early markers of cardiovascular disease (d = 0.0-0.6) despite successful insomnia treatment (d = 1.3). Potential methodological and conceptual reasons for these negative findings are discussed. Future studies might include larger sample sizes that are at risk of cardiovascular diseases and focus on other cardiovascular markers.
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Affiliation(s)
- Anna Friederike Johann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Umair Akram
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK.,Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK
| | - Florian Holub
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Chiara Baglioni
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Department of Human Sciences, University of Rome 'G. Marconi' - Telematic, Rome, Italy
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Simon D Kyle
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jürgen Biermann
- Department of Cardiology and Angiology, Cardiac Electrophysiology, St. Franziskus-Hospital Münster, Münster, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
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